Efficacy of fire needle on patients of facial spasm: A protocol for systematic review and meta analysis

BACKGROUND

Facial spasm causes a lot of troubles to patients daily life and seriously affects their mental and physical health. Relevant studies have shown that fire needle therapy has certain benefits for facial spasm, is an integral part of acupuncture therapy. However, there is no unanimous conclusion. The main purpose of our study is to measure whether fire needle therapy is effective for facial spasm.

METHODS

The following electronic databases will be searched for the collection of fire-needle related randomized controlled trials (RCTS) for facial spasm, including 4 English databases (Web of Science, the Cochrane Library, EMBASE, Pubmed) and 3 Chinese databases (Chinese National Knowledge Infrastructure [CNKI], Wanfang data, Chinese VIP Information). The cure rate and total effective rate are the main outcomes, while the intensity, frequency, recurrence rate and adverse events are the secondary outcomes. We will use Endnote software X9 for study selection, Review Manager software 5.4 and STATA 13.0 software for analysis and synthesis.

RESULTS

We will evaluate the efficacy of fire needles in the treatment of facial spasm in combination with current studies.

CONCLUSION

The conclusion of this study will provide evidence for the efficacy of fire needle in the treatment of facial spasm.

TRIAL REGISTRATION NUMBER

INPLASY202080036.

[Application status and prospect of botulinum toxin A in otorhinolaryngological treatment]

Botulinum toxin A is a kind of neurotoxin produced by clostridium botulinum, and has been applied for nearly thirty years in China.The target of BTX-A is to selectively cleave the synaptosome-associated protein of 25 KD molecular mass, commonly abbreviated SNAP-25, thereby inhibiting neurotransmitter release and causing chemodenervation. The potential application of botulinum toxin A in treating the spasmodic dysphonia, hemifacial spasm, tinnitus, rhinitis has been confirmed both in clinical practice and previous studies. This paper is to review comprehensively the application status and the prospect of botulinum toxin A in otorhinolaryngological treatment.

Acupuncture therapy for patients with hemifacial spasm: A protocol of systematic review and meta-analysis

BACKGROUND

Hemifacial spasm (HFS) brings a lot of trouble to patients' daily life, having a severe influence on the psychological and physical wellbeing of patients. Relevant researches suggested that acupuncture therapy has potential benefits for HFS. However, there is no consistent conclusion. The purpose of our study is to assess whether acupuncture therapy is effective and safe for HFS.

METHODS

To collect relevant randomized controlled trials (RCTs), the following electronic databases will be searched: Web of Science, the Cochrane Library, EMBASE, MEDLINE, ISI Web of Knowledge, PsycINFO, Allied and Alternative Medieine, Chinese National Knowledge Infrastructure, Wanfang data, and Chinese Scientific Journals Database. We will take the cure rate and the total effective rate as the primary outcomes, and change in intensity after treatment, change in frequency after treatment, the recurrence rate, and adverse events as secondary outcomes. Endnote software 9.1 will be used for study selection, Review Manager software 5.3, and STATA 13.0 software will be used for analysis and synthesis.

RESULTS

Current relevant studies will be synthesized to assess whether acupuncture therapy is effective and safe for HFS.

CONCLUSION

Our research will provide evidence of acupuncture therapy for HFS.

REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) CRD42019142473.

[Tinnitus in patients with hemifacial spasm: a treatable combination?]

BACKGROUND

About 5-15% of people in the Western world will suffer from an extended period of tinnitus during their lifetime. This is often a non-treatable, disabling disorder. Tinnitus can be classified as pulsatile or non-pulsatile. Pulsatile tinnitus can be caused by a treatable neurovascular compression.

CASE DESCRIPTION

Here we describe two patients, a 68-year old woman and 40-year old man suffering from pulsatile tinnitus and hemifacial spams due to neurovascular compression of the facial and acoustic nerve in the anterior cranial fossa. After microvascular decompression using the Jannetta procedure, in which a sponge was placed between the blood vessel and the nerve, the tinnitus and hemifacial spasm disappeared.

CONCLUSION

Recognition of hemifacial spasm in patients with tinnitus is important because the symptoms are treatable when it is due to neurovascular compression. Because hemifacial spasm can manifest in subtle forms - for instance unilateral blinking - this important symptom can easily be overlooked.

Vagoglossopharyngeal Neuralgia Occurred Concomitantly with Ipsilateral Hemifacial Spasm and Versive Seizure-Like Movement: A First Case Report

Vagoglossopharyngeal neuralgia (VGPN) is a very rare condition. VGPN with convulsive like attack is even rarer All of the cases had their head turned to the opposite side of facial pain. Hemifacial spasm occurring concurrently with VGPN has never been reported. Herein, we present the first case of VGPN that had ipsilateral hemifacial spasm and versive seizure-like movement to the same side of facial pain. We reported a 71-year-old man presenting with multiple episodes of intermittent sharp shooting pain arising on the right middle neck, followed by hemifacial spasm on right face. Then the patient became syncope while his head and gaze turned to the same side of the painful neck. Electrocardiography showed sinus arrest. Interictal Electroencephalography was normal. This patient initially responded to pregabalin for two weeks, then the symptoms became worse. Microvascular decompression and carbamazepine resulted in the complete remission of all symptoms after six months of follow-up. We could not explain the pathophysiology of unilateral versive seizure like movement.

[Clinical observation of fire needle for facial spasm]

OBJECTIVE

To compare the effects between fire needle combined with acupuncture and simple acupuncture for facial spasm.

METHODS

Sixty patients with facial spasm were randomly divided into a fire needle group and an acupuncture group, 30 cases in each one. In the two groups, acupuncture was used at Fengchi (GB 20), Baihui(GV 20), Shenting (GV 24), Zusanli(ST 36) and Yanglingquan(GB 34). The needles were retained for 30 min. In the fire needle group, ashi points in the spasm areas were pricked by fire needles without retaining. In the acupuncture group, acupuncture was retained at ashi points. In the first two weeks,the treatment was given once a day, totally 10 times, and there were two days to have a rest after 5-day treatment. But patients were treated once every other day, three times a week, and totally 20 times from the third week. Fire needle and acupuncture were applied at ashi points until spasm was relieved. The facial spasm degree and frequency were observed after the 15th treatment and the 30th treatment,and the clinical effects were assessed in the two groups.

RESULTS

After treatment the facial spasm degree and frequency were relieved than those before treatment in the two groups (all P < 0.05). Ones in the fire needle group were declined more apparently than those in the acupuncture group (both P < 0.05). After the 15th treatment and the 30th treatment,the cured rates and the total effective rates in the fire needle group were better than those in the acupuncture group [after the 15th treatment: 20.0% (6/30) vs. 10.0% (3/30), 80.0% (24/30) vs. 63.3% (19/30), both P < 0.05; after the 30th treatment: 33.3% (10/30) vs. 20.0% (6/30), 93.3% (28/30) vs. 80.0% (24/30), both P < 0.05].

CONCLUSION

The efficacy of fire needle is superior to that of simple acupuncture for facial spasm.

Facial Weakness, Otalgia, and Hemifacial Spasm: A Novel Neurological Syndrome in a Case-Series of 3 Patients With Rheumatic Disease

Bell palsy occurs in different rheumatic diseases, causes hemifacial weakness, and targets the motor branch of the 7th cranial nerve. Severe, persistent, and refractory otalgia having features of neuropathic pain (ie, burning and allodynic) does not characteristically occur with Bell palsy. Whereas aberrant regeneration of the 7th cranial nerve occurring after a Bell palsy may lead to a variety of clinical findings, hemifacial spasm only rarely occurs. We identified in 3 rheumatic disease patients (2 with Sjögren syndrome, 1 with rheumatoid arthritis) a previously unreported neurological syndrome of facial weakness, otalgia with neuropathic pain features, and hemifacial spasm. We characterized symptoms, examination findings, and response to therapy. All 3 patients experienced vertigo, as well as severe otalgia which persisted after mild facial weakness had completely resolved within 1 to 4 weeks. The allodynic nature of otalgia was striking. Two patients were rendered homebound, as even the barest graze of outdoor breezes caused intolerable ear pain. Patients developed hemifacial spasm either at the time of or within 3 months of facial weakness. Two patients had a polyphasic course, with recurrent episodes of facial weakness and increased otalgia. In all cases, otalgia and hemifacial spasm were unresponsive to neuropathic pain regimens, but responded in 1 case to intravenous immunoglobulin therapy. No patients had vesicles or varicella zoster virus in spinal-fluid studies. We have defined a novel neurological syndrome in 3 rheumatic disease patients, characterized by facial weakness, otalgia, and hemifacial spasm. As described in infectious disorders, the combination of otalgia, facial weakness, and 8th cranial nerve deficits suggests damage to the geniculate ganglia (ie, the sensory ganglia of the 7th cranial nerve), with contiguous involvement of other cranial nerves causing facial weakness and vertigo. However, the relapsing nature and association with hemifacial spasm constitute a unique part of this neurological syndrome.

Complementary therapies in hemifacial spasm and comparison with other movement disorders

OBJECTIVES

We determined the prevalence, range and factors influencing the use of complementary therapy among hemifacial spasm patients and compared the patterns of use of complementary therapies across different movement disorders in a systematic pooled analysis of published literature.

METHODS

A structured questionnaire was administered to 96 hemifacial spasm patients evaluating frequency of complementary therapy use, and factors influencing patients' decision to seek these therapies. We also performed a PubMed search of epidemiology studies on use of complementary therapies in movement disorders.

RESULTS

Fifty-one per cent of patients had tried complementary therapies, of which 47% reported some perceived benefit and 4.1% informed their doctor. Acupuncture (71.4%) and facial massage (17.6%) were most commonly used. Complementary therapy use was associated with greater HFS severity. The mean cost of treatment was about $78 per month. We identified eight articles on use of complementary therapies in movement disorders; Parkinson's disease (5), Tourette syndrome (2) and dystonia (1). Twenty-five to 88% of patient had tried complementary therapies, of which 32-70% reported some benefit. Trials of acupuncture (2-63%) and massage (7-38%) were reported across the spectrum of movement disorders studied. Mean cost of complementary therapies varied from 43 to 102 USD per month.

CONCLUSION

Complementary therapies are used by over 50% of HFS patients, and the use is correlated with severity of disease. Despite differences in race, culture and population demographics, acupuncture and massage are used by patients across the spectrum of movement disorders.

Endovascular treatment of hemifacial spasm associated with a petrosal DAVF using transarterial Onyx embolization. A case report

This paper reports that decompression of the facial nerve by transarterial Onyx embolization may relieve hemifacial spasm (HFS) caused by dilated veins due to a right petrosal dural arteriovenous fistula (DAVF). A 56-year-old man suffered severe chronic right HFS associated with a dilated right petrosal vein lying in the vicinity of the facial nerve. The right petrosal DAVF was reached through the middle meningeal artery using a transfemoral arterial approach and was occluded with Onyx 18 (M.T.I.- ev3, Irvine, CA, USA). There was complete remission of HFS without recurrence after two months of follow-up. This case supports vascular compression in the pathogenesis of HFS and suggests that facial nerve injury caused by a DAVF could be treated with transarterial Onyx embolization.

Hemifacial spasm

Hemifacial spasm (HFS) is a peripherally induced movement disorder causing clonic or tonic contractions of the facial muscles. HFS is usually unilateral and sporadic. It may be primary (mainly attributed to vascular compressions of the seventh cranial nerve in the posterior fossa) or secondary to facial nerve or brainstem damage. The two forms share a number of features but may differ in clinical presentation (simultaneous involvement of the upper and lower facial muscles in secondary forms). The spasm-related electromyogram activity is probably generated by ephaptic transmission, due to local demyelination at the entry zone of the facial nerve root (possibly owing to nerve damage caused by a compressing cerebral vessel). These findings suggest the "nerve origin hypothesis" as the main pathophysiological mechanism underlying HFS. Medical treatment (anticonvulsants or GABAergic drugs) is generally ineffective. Microvascular decompression of the facial nerve can achieve marked improvements in the majority of patients, although recurrences and complications are not uncommon. Local (orbicularis oculi or lower facial muscles) injection of Botulinum toxin (BoNT) is therefore considered the preferred symptomatic treatment for primary HFS. The long-term efficacy and safety of BoNT have been documented by clinical studies.

[Observation on therapeutic effect of fire needle therapy on facial spasm]

OBJECTIVE

To compare therapeutic effects of fire needle therapy and filiform needle therapy on facial spasm.

METHODS

One hundred and twenty-seven cases of such disease were divided into two groups. The treatment group (n=79) were treated with fire needle therapy at Taiyang (EX-HN 5), Cuanzhu (BL 2) and Quanliao (SI 18), and the control group (n=48) with filiform needle therapy at the same acupoints as those in the treatment group. Their therapeutic effects were compared.

RESULTS

The cured rate and the effective rate were 64.6% and 92.4% in the treatment group, and 45.8% and 87.5% in the control group, respectively, with a significant difference between the two groups (P < 0.05).

CONCLUSION

Fire needle therapy is an effective therapy for facial spasm, with a therapeutic effect better than that of filiform needle therapy.

[Clinical observation on acupuncture plus laser radiation for treatment of facial spasm]

OBJECTIVE

To search for a convenient, safe and effective method for treatment of facial spasm.

METHODS

Three hundred and ninety cases of facial spasm were divided into 2 groups in order of visiting: medication group of 200 cases were treated with routine medicine, and acupuncture and laser treatment group of 190 cases treated with acupuncture plus laser radiation. After treatment of 30 days, their therapeutic effects were summarized.

RESULTS

The total effective rate, the cured rate and the 6-month recurrence rate were 93.7%, 64.7%, 6.7% in the acupuncture and laser treatment group, and the corresponding figures were 62.0%, 32.0% and 33.9% in the medication group respectively, with a very significant difference between the two groups in the therapeutic effect (P < 0.01).

CONCLUSION

Acupuncture plus laser radiation is a convenient and safe method for treatment of facial spasm.

Hemifacial spasm associated with otitis media with effusion: a first reported case

Hemifacial spasm is a condition consisting of unilateral paroxysmal involuntary contractions of the muscles innervated by the facial nerve. The most common etiology is a vascular loop compression at the root exit zone of the nerve. We present here a first reported case of hemifacial spasm associated with otitis media with effusion, in a 6-year-old girl, which was relieved immediately following ventilation tubes insertion. A proposed mechanism is described.

Vaskuläre Erkrankungen des Kleinhirnbrückenwinkels

Vascular anomalies of the cerebellopontine angle are rare compared to tumors in this area. Irritation of the trigeminal, facial, or vestibulocochlear nerve may cause trigeminal neuralgia, hemifacial spasm and vertigo, or tinnitus accordingly. Vessel loops in the cerebellopontine cisterns may cause compression at the root entry or exit zone of the cranial nerves V, VII, and VIII, a phenomenon which is called "vascular loop syndrome." Megadolichobasilar artery and aneurysms of the vertebrobasilar system can also lead to dislocation and compression of the cranial nerves and brain stem. Three-dimensional CISS MR imaging and MR angiography are useful in the detection of neurovascular compression. Microvascular decompression is an effective surgical procedure in the management of compression syndromes of the cranial nerves V, VII, and VIII.

Hemifacial spasm resulting from vertebral artery dolichoectasia

A 32-year-old man presented with left hemifacial spasm. Neurophysiological findings revealed an absent ipsilateral R1 on blink reflex. An MRI showed a dolichoectatic left vertebral artery impinging on the root exit zone of the left facial nerve. Botulinum toxin infections relieved the manifestations of hemifacial spasm. This case demonstrates that MRI/MRA is an essential part of the work-up for hemifacial spasm, and shows that in accordance with the literature, vertebral dolichoectasia is an uncommon cause of hemifacial spasm.

Creutzfeldt-Jakob Disease and Cadaveric Dura Mater Grafts in Japan: An Updated Analysis of Incubation Time

The incubation time for 76 patients with cadaveric dura mater-transmitted Creutzfeldt-Jakob disease reported in Japan by November 2001 was analyzed to clarify its distributional feature and the risk factors which affect the earlier onset of the disease. Cluster analysis indicated that cases could be divided into 3 clusters with respect to the incubation time, i.e., short (1.4-6.2 years), medium (7.0-11.9 years) and long (12.9-17.6 years). The incubation time in females was significantly shorter than those in males. Patients who were transplanted dura mater for facial spasms had a significantly shorter incubation time than those who received transplantation for other diseases including meningioma, aneurysm, or acoustic schwannoma. These results suggest that some host factors may have an influence on the incubation time of the disease.

Monitoring of the lateral spread response in the endovascular treatment of a hemifacial spasm caused by an unruptured vertebral artery aneurysm

✓ The lateral spread response (LSR) is used in the electrophysiological diagnosis of a hemifacial spasm or for monitoring during microvascular decompression. The authors used LSRs for intraoperative monitoring during endovascular surgery in a rare case of vertebral artery (VA) aneurysm that caused intractable hemifacial spasm.

A 49-year-old woman presented with a right hemifacial spasm that had persisted for 9 months. No other clinical symptom was observed. Vertebral artery angiography revealed a saccular aneurysm of the right VA. Magnetic resonance (MR) imaging demonstrated that the aneurysm was compressing the root exit zone of the right facial nerve. Endovascular treatment of the VA aneurysm was performed while monitoring the patient's LSRs. During occlusion of the VA at sites distal and proximal to the aneurysm, the LSRs temporarily disappeared and then reappeared with a higher amplitude than those measured preceding their disappearance. The hemifacial spasm alleviated gradually and disappeared completely 6 months after treatment. The LSRs changed in parallel with the improvement in the patient's hemifacial spasms and eventually disappeared. No recurrence of symptoms has been noticed as of 18 months postoperatively.

This is the first report of the use of LSR monitoring during endovascular surgery for an intracranial aneurysm that causes hemifacial spasm. Intraoperative and postoperative changes in the LSRs provided useful information regarding the pathophysiology of hemifacial spasm.

Mind-refreshing acupuncture therapy for facial spasm, trigeminal neuralgia and stubborn facial paralysis

It has been proved by clinical experiment that needling at Fengchi (GB 20), Wangu (GB 12) and Tianzhu (BL 10) can markedly improve the blood supply to the vertebral basilar artery, increase the cerebral blood flow, and relax the spasm of the vascular smooth muscles. The combined use of Shangxing (GV 23) and Yintang (EX-HN3) can give the effects of resuscitating and tranquilizing the mind, dispelling wind, dredging the channels, and relieving spasm and pain. In short, the above therapy may turn the pathological state into a normal physiological state, and bring a quicker recovery for patients with facial spasm, trigeminal neuralgia and stubborn facial paralysis.

Hemifacial spasm in Singapore: clinical characteristics and patients ' perceptions

INTRODUCTION

The aim of this study was to determine the clinical characteristics and patients ' perception of hemifacial spasm (HFS) in Singapore.

MATERIALS AND METHODS

A clinical survey of 137 consecutive patients with HFS seen in our Botulinum Toxin Clinic over a 15-month period was undertaken.

RESULTS

Forty-six men and 91 women were interviewed. Their mean age at onset of HFS was 48 years. The median disease duration was 60 months (range, 2 to 360 months). Left-sided spasm was common in 51.8 % of patients, and the orbicularis oculi was the first muscle to be affected in 86.1 % of them. The majority (65 %) had the spasm aggravated by stress and anxiety. In fact, 32 patients perceived stress and anxiety as a possible aetiology of HFS. Stroke was a main concern in 17 patients and 7 patients thought the spasm was a sign of demonic possession or a bad omen. The spasm embarrassed 75.2 % of the patients, rendered 65 % of them depressed, affected the vision in 60.6 % of them and compromised their work performance in 35.8 %. Overall, treatment was delayed by a median interval of 6 months from onset of symptoms (range, 0 to 132). More than half (53.3 %) tried traditional therapies (acupuncture or herbal medicine), while only 48.2 % had botulinum toxin as the initial treatment. All patients eventually received botulinum toxin injections and more than 90 % showed improvement at 1 month posttreatment.

CONCLUSIONS

The clinical characteristics and patients ' perception of HFS in Singapore were presented. HFS affects patients both psychosocially and functionally. Effective treatment with botulinum toxin exists and should be provided early to the patients.

[Cranial nerve vascular compression syndromes and neurogenic hypertension]

The presented paper is a review of syndromes which till recently had an obscure cause and still have attributes such as "primary" or "essential". Their common denominator is vascular compression of the roots of the appropriate cephalic nerves. The syndromes include trigeminal neuralgia, glossopharyngeal neuralgia, hemifacial spasm, some forms of tinnitus and vertigo, exceptionally toricollis. Vascular compression of the ventrolateral oblongata on the left leads to neurogenic hypertension. The author discusses the state of knowledge on the aetiology of syndromes, the clinical and laboratory research of which contributed some findings on the physiology and pathophysiology of the mentioned conditions. At the same time the authors present their own experience with the therapeutic method of syndromes--microvascular decompression.

[Treatment of local hyperkinesis]

Insufficient effectiveness of medicamentous therapy of local hyperkineses necessitated quest for other treatment options. In view of pathogenetic features of this pathological process we have chosen reflexotherapy to be instituted in our patients: auriculopuncture, electro-corporal- and acupuncture which have been shown to be expedient and effective in treating 65 patients with local hyperkinesis (blepharospasm, facial paraspasm, writer's spasm, spasmodic torticollis). Positive findings from clinical and paraclinical methods of investigation corroborate the results of the treatments administered.

Hemifacial spasm and involuntary facial movements

Hemifacial spasm (HFS) is characterized by tonic and clonic contractions of the muscles innervated by the ipsilateral facial nerve. It is important to distinguish this from other causes of facial spasms, such as psychogenic facial spasm, facial tic, facial myokymia, blepharospasm, and tardive dyskinesia. Magnetic resonance imaging and angiography studies frequently demonstrate vascular compression of the root exit zone of the facial nerve. Importantly, an underlying space-occupying lesion needs to be excluded in patients with associated atypical features such as facial numbness and weakness. Botulinum toxin injection to the facial muscles is an effective treatment for HFS, with few disabling side-effects.

Familial hemifacial spasm: report of cases and review of literature

We describe clinical characteristics of 10 patients (five families) with familial hemifacial spasm, with reviews of 13 patients hitherto reported in the literature. There is no clear difference in clinical manifestations between sporadic and familial hemifacial spasms. There is no definite inheritance pattern, but may be autosomal dominant with low penetrance. The ages of onset of familial hemifacial spasm are variable, but occasionally can occur at early years of life. There is a left-side predominance with respect to the affected side of cases with familial hemifacial spasm. Similar to sporadic hemifacial spasm, vascular decompression was effective, suggesting that vascular compression is involved in generating hemifacial spasm even in the familial cases. Familial hemifacial spasm may not be a rare disorder, but may possibly be overlooked. Clarifying the role of genetic susceptibility in pathophysiological mechanisms underlying hemifacial spasm is an important approach toward better understanding of the pathogenesis of cranial rhizopathies.

[Microvascular decompression for hemifacial spasm: experience of 215 cases]

OBJECTIVE

To investigate the relationship between pre-operational etiological diagnosis of medically intractable hemifacial spasm (HFS) and patterns of offending vessels and the curative effect of microvascular decompression (MVD).

METHODS

Two hundred and fifteen patients with medically intractable HFS underwent MVD under general anesthesia. Pre-operative MRI examination was made for all cases to exclude space occupying lesion and magnetic imaging tomographic angiography (MRTA) was conducted for 145 cases of them instead of routine MRI.

RESULTS

Routine MRI failed to provide information about offending vessels except for ruling out mass lesions whereas MRTA revealed the offending vessels with a positive rate of 82.8%, thus helping make correct diagnosis and operation decision. Follow-up of more than two years showed that the surgical intervention achieved a high relief rate of 91.2% without major complication, and with a low recurrence rate of only 3.5% after averaging more than two years' follow-up.

CONCLUSION

Pre-operative MRTA can replace conventional MRI as a best approach for pre-operational etiological diagnosis of facial spasm. It helps perceive the offending vessels before operation. Skilled microsurgical technique along with correct recognition and mobilization of offending vessels are a must to assure MVD a high efficacious and low risk treatment of choice for HFS patients.

Fusiform aneurysm of the vertebral artery presenting hemifacial spasm treated by intravascular embolization: case report

BACKGROUND

A rare case of fusiform vertebral artery aneurysm causing hemifacial spasm was successfully treated by intravascular embolization.

CASE DESCRIPTION

A 53-year-old man presented with left hemifacial spasm persisting for 2 years. No other clinical symptoms were observed. Vertebral angiography revealed a fusiform aneurysm of the left vertebral artery, and thin-slice spoiled gradient-recalled acquisition magnetic resonance imaging demonstrated the aneurysm compressing the root exit zone of the left facial nerve. The parent artery was occluded together with the aneurysm by intravascular embolization with Guglielmi detachable coils (GDCs). The patient is free of left hemifacial spasm without any complication.

CONCLUSION

Hemifacial spasm caused by aneurysms, especially fusiform aneurysms, is quite rare but can be treated by parent artery occlusion and coiling the aneurysm with GDCs.

Botulinum toxin in otolaryngology: a review of its actions and opportunities for use

Botulinum toxin has several important properties that make it an ideal chemical denervator. These include its high degree of specificity for the neuromuscular junction, its ability to induce temporary and reversible denervation, and its limited degree of side effects and complications. Botulinum toxin is being used safely in a wide variety of clinical settings by many different specialists. In otolaryngologic practice, it is being administered for the treatment of at least a dozen conditions, including various dysphonias, dystonias, and spasms as well as torticollis, facial nerve paralysis, and hyperkinetic facial lines. Studies have shown that botulinum toxin injections have a high rate of success in temporarily relieving symptoms.

Treatment of 86 cases of facial spasm by acupuncture and pressure on otopoints

The combined method of acupuncture with pressure on otopoints (the combination group) was used to treat 86 patients with facial spasm; and simple acupuncture and simple pressure on otopoints were respectively applied in the other two groups of patients as controls. The total effective rates of the combination group, the acupuncture group and the pressure on otopoints group were 95.4%, 92.1% and 62.5% respectively; and the cure rates were 38.4%, 15.8% and 5% respectively. The differences in results of the three groups show statistically marked significance, indicating that the therapeutic effectiveness of the combined method of acupuncture with pressure on otopoints is better than the other two therapeutic methods.

[Hemifacial spasm, quality of life and depression]

INTRODUCTION

Quality of life, a concept which has become increasingly important in recent years, refers to a patient's perception of himself in relation to his illness and its treatment. This is compared with the concept of quantity of life or survival. This approach is in keeping with the concepts of health of the World Health Organization. Hemifacial spasm is a disorder of movement with a prevalence of 7.4 and 14.5 per 100,000 men and women respectively.

OBJECTIVE

To evaluate the quality of life of patients with hemifacial spasm, study the occurrence of depression and ascertain whether it correlates with the severity, response to treatment and muscle groups involved.

PATIENTS AND METHODS

We present a cohort of 57 patients (average age 53.4 years) with hemifacial spasm, in whom the disorder had been present for an average of 3.7 years.

RESULTS

It was found that in these patients the quality of life and index of depression were worse when the severity of the disease was greater, response to treatment poorer and there was generalized hemifacial paralysis, (p < 0.00000) for each parameter. The deterioration in quality of life was correlated with depression (correlation 0.6) for the criteria of severity and muscle groups involved, but not with the response to treatment (correlation 0.3).

CONCLUSION

Hemifacial spasm significantly alters the quality of life of patients and is associated with depression. This should be taken into account when treating such patients.

[Torticollis spasmodicus, blepharospasm and hemifacial spasm. Subjective evaluation of therapy by patients]

Injections with botulinum toxin type A (BTX) are considered the first-line treatment for spasmodic torticollis (ST), blepharospasm (BL) and hemifacial spasm (HFS). Because BTX brings only temporary and partial relief, patients frequently try other additional therapies to minimize their symptoms. The subjective rating of all therapies ever tried by patients with ST, BL and HFS was evaluated by using a simple questionnaire. Two hundred questionnaires were considered (112 TS, 54 BL, 34 HFS). BTX was rated subjectively the best therapy in all three diagnostic groups (median: 2 = good effect). Despite Citalopram and physiotherapy (median: 3 = average effect), all other therapies were rated with a median of > or = 4 (= minimal effect). Patients with ST tried 7.7, patients with BL 2.4 and patients with HFS 2.6 different types of therapy. In conclusion, BTX is the most effective treatment for patients with ST, BL and HFS, as rated subjectively. Further evaluation of therapies additional to BTX injections is recommended.

Endovascular treatment of hemifacial spasm associated with a cerebral arteriovenous malformation using transvenous embolization: case report

OBJECTIVE AND IMPORTANCE

To illustrate that decompression of the facial nerve by transvenous endovascular treatment may relieve hemifacial spasm (HFS) caused by dilated veins.

CLINICAL PRESENTATION

A 35-year-old man suffered severe chronic right HFS associated with a dilated right lateral mesencephalic vein lying in the vicinity of the facial nerve. This nonessential vein was recruited as a secondary collateral drainage from an inoperable left temporo-occipital arteriovenous malformation.

INTERVENTION

The lateral mesencephalic vein was reached through the superior petrosal sinus using a transfemoral venous approach and was occluded with interlocking detachable coils (Target Therapeutics, Freemont, CA). There was complete remission of HFS without recurrence after 2.5 years of follow-up.

CONCLUSION

This case report supports vascular compression in the pathogenesis of HFS and suggests that facial nerve injury is not essential for the therapeutic effect of surgical decompression.

Combined hyperactive dysfunction syndrome of the cranial nerves: trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia: 11-year experience and review

OBJECTIVE

A pathological condition caused by vascular compression at the root entry/exit zone of the cranial nerves is designated hyperactive dysfunction syndrome (HDS) of the cranial nerves. Patients with HDS who exhibited a combination of trigeminal neuralgia (TN), hemifacial spasm (HFS), and/or glossopharyngeal neuralgia were retrospectively reviewed, to study the incidence, etiological factors, and demographic characteristics for this combined HDS group.

METHODS

Medical and surgical records were analyzed for 41 patients with combined HDS, of 1472 consecutive patients with HDS who were treated between 1984 and 1994.

RESULTS

The combined HDS group accounted for 2.8% of all patients with HDS; 19 patients (1.3%) exhibited bilateral symptoms, i.e., 14 cases of TN, 3 of combined TN and HFS, and 2 of HFS. Twenty-two patients (1.5%) exhibited ipsilateral symptoms, i.e., 19 cases of TN and HFS and 3 of TN and glossopharyngeal neuralgia. Excluding three patients whose symptoms were associated with brain tumors or arteriovenous malformations, this patient group was older (63.2 versus 55.3 yr, P = 0.0009) and exhibited an increased percentage of associated hypertension (47.4 versus 17.5%, P = 0.000008), with a female predominance (86.8 versus 71.3%, P = 0.07), compared with the single HDS group. Thirty-six of these patients underwent a total of 61 microvascular decompression procedures, with favorable outcomes. The offending vessels were similar to those in single HDS, which were usually conventional and multiple.

CONCLUSION

The associated etiological factors for vascular compression syndromes were more evident in the combined HDS group than in the single HDS group. Progressive arteriosclerotic vasculoarchitectural changes of the vertebrobasilar system, accelerated by aging and hypertension, bring about the development of combined HDS, with a remarkable female predominance.

[Blepharospasm and hemifacial spasm treated with botulinum A toxin injection]

OBJECTIVE

To study the efficacy of botulinum A toxin (BTA) injections for the treatment of blepharospasm and hemifacial spasm (HFS).

METHODS

Twelve patients with blepharospasm and thirty eight patients with HFS were treated with BTA local injections (2.5 U to 5 U for each injection).

RESULTS

Of the fifty patients, ten (86.7%) in blepharospasm and thirty two (84.2%) in HFS were completely relieved, two (13.3%) and five (13.2%) were remarkably relieved respectively, zero and one (2.6%) were partial relieved respectively. All patients experienced relief from spasm. The duration of the effect in blepharospasm were 10 to 24 weeks (mean, 18 weeks) and in HFS 14 to 32 weeks (mean, 22 weeks). The local side effects were transient and mild, including minor facial paralysis in eight patients, ptosis in four patients and tearing in four patients. No systemic adverse and allergic reactions were noted.

CONCLUSION

Botulinum A toxin local injection is a safe, effective and simple means for the treatment of blepharospasm and HFS.